Abstract
BackgroundThalassemia is a common inherited hemoglobin disorder in Southeast Asia. Severe thalassemia can lead to significant morbidity for patients and economic strain for under-resourced health systems. Thailand’s thalassemia prevention and control program has successfully utilized prenatal screening and diagnosis to reduce the incidence of severe thalassemia in Thai populations, but migrant populations are excluded despite having high thalassemia prevalence. We sought to identify key barriers to and facilitators of thalassemia screening and to develop tailored recommendations for providing migrants with access to thalassemia prevention and control.MethodsWe conducted 28 in-depth interviews and 4 focus group discussions (FGDs) in Chonburi, Thailand with Myanmar and Cambodian migrants, Thai healthcare providers, Thai parents of children affected by thalassemia, and migrant agents.ResultsParticipant narratives revealed that migrants’ lack of knowledge about the prevalence, manifestations, severity, and inherited nature of thalassemia led to misconceptions, fear, or indifference toward thalassemia and screening. Negative perceptions of pregnancy termination were based in religious beliefs but compounded by other sociocultural factors, presenting a key obstacle to migrant uptake of prenatal screening. Additionally, structural barriers included legal status, competing work demands, lack of health insurance, and language barriers. Participants recommended delivering public thalassemia education in migrants’ native languages, implementing carrier screening, and offering thalassemia screening in convenient settings.ConclusionsAn effective thalassemia prevention and control program should offer migrants targeted thalassemia education and outreach, universal coverage for thalassemia screening and prenatal care, and options for carrier screening, providing a comprehensive strategy for reducing the incidence of severe thalassemia in Thailand and establishing an inclusive model for regional thalassemia prevention and control.
Highlights
Thalassemia is a common inherited hemoglobin disorder in Southeast Asia
Migrants reported residing in Thailand for 8.2 years on average, with migrant agents reporting longer lengths of residence and possessing greater Thai fluency and more familiarity with Thai health systems compared to migrant workers
We identified three main themes reflecting different categories of barriers and facilitators to successful thalassemia prevention in migrants (Fig. 1): (1) lack of knowledge about thalassemia leading to negative attitudes toward screening, (2) sociocultural factors influencing uptake of thalassemia screening and termination of pregnancy, and (3) structural and systemic factors affecting access to thalassemia screening and interventions
Summary
Thalassemia is a common inherited hemoglobin disorder in Southeast Asia. Severe thalassemia can lead to significant morbidity for patients and economic strain for under-resourced health systems. Thalassemia syndromes are common inherited disorders characterized by mutations leading to the underproduction of α- or β-globin proteins and are a major contributor to the global burden of anemia [1]. As a result of its relative stable and prosperous economy, Thailand has become a main destination for regional migration, hosting ~ 3.9 million migrants, mainly from neighboring Myanmar, Cambodia, and Laos [6]. These large-scale migrations have the potential to change the epidemiology of thalassemia significantly, representing new challenges to health systems in impacted countries [7,8,9,10]. Little attention has been paid to mass migrations within SEA and its implications on regional prevention and control of thalassemia
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